What is Migraleve used for?

Short-term (up to three days) treatment of nausea and headache associated with a migraine attack when this is not relieved by paracetamol, ibuprofen or aspirin alone.

The Migraleve pink tablets are taken first, at the first sign of a migraine, to help prevent the migraine developing fully. They contain two painkillers, paracetamol and codeine (a combination known as co-codamol), together with an anti-sickness medicine called buclizine.

If the migraine continues after taking Migraleve pink, further treatment should be with the Migraleve yellow tablets to help relieve the headache. The Migraleve yellow tablets contain just the painkillers, paracetamol and codeine.

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How does Migraleve work?

The buclizine in Migraleve pink is used to treat the sensation of nausea that can occur in a migraine attack and thus prevent vomiting. It works by stopping the vomiting centre in the brain from receiving nerve messages that would otherwise cause nausea and vomiting.

The paracetamol in both types of tablets is thought to relieve pain by reducing the production of prostaglandins in the brain and spinal cord. Prostaglandins sensitise nerve endings, causing pain. By reducing their production paracetamol is thought to increase our pain threshold, so that although the cause of the pain remains, we can feel it less.

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The codeine in both types of tablets is a slightly stronger painkiller known as an opioid. Opioid painkillers work by mimicking the action of natural pain-reducing chemicals called endorphins that are produced in the brain and spinal cord. Codeine acts on the same opioid receptors as natural endorphins and this blocks the transmission of pain signals sent by the nerves to the brain. This means that even though the cause of the pain may remain, less pain is actually felt.

Migraleve pink and yellow tablets contain 8mg of codeine, which in combination with the paracetamol is effective at relieving the pain of migraine headaches.

How do I take Migraleve?

Migraleve pink and yellow tablets can be taken either with or without food.

Adults over 18 years of age should take two Migraleve pink tablets at the first sign of a migraine. If after four hours the headache is still there, you should then take two Migraleve yellow tablets every four hours as necessary. Maximum dose: eight tablets (two Migraleve pink and six Migraleve yellow) in 24 hours.

Adolescents aged 15 to 18 years should take two Migraleve pink tablets at the first sign of a migraine. If after six hours the headache is still there, you should then take two Migraleve yellow tablets every six hours as necessary. Maximum dose: eight tablets (two Migraleve pink and six Migraleve yellow) in 24 hours.

Children aged 12 to 14 years should take one Migraleve pink tablet as soon as it is known that a migraine attack has started or is imminent. If after six hours the migraine is still there, one Migraleve yellow tablet should then be taken every six hours as necessary. Maximum dose: four tablets (one Migraleve pink and three Migraleve yellow) in 24 hours.

Do not take more than the recommended dose.

Do not take Migraleve for longer than three days without consulting your doctor. Taking codeine regularly for more than three days can lead to addiction to the medicine and withdrawal symptoms when you stop taking it.

What should I know before taking Migraleve?

Migraleve may cause drowsiness, dizziness and blurred vision. If you are affected you should not drive or operate machinery and avoid drinking alcohol.

In March 2015 a new 'drug driving' law came into force that allows police to use roadside drug tests to check for the presence of prohibited drugs in a driver's saliva. The medicines prohibited by the law include morphine. Codeine is converted into morphine by the liver, which means it may be an offence to drive while you are taking Migraleve. You should not drive if you think this medicine affects your ability to drive safely, for example if it makes you feel sleepy, dizzy, unable to concentrate or make decisions, or if you have blurred or double vision.

People can vary considerably in the way that their body metabolises codeine. For some people this may lead to an increased chance of getting side effects, such as reduced levels of consciousness; sleepiness; slow, shallow breathing; 'pin-point' pupils; lack of appetite; constipation; or nausea and vomiting. If you experience any of these you should stop using Migraleve and get medical advice straight away. For other people it may mean that the codeine is less effective, so if you find this medicine doesn't relieve your symptoms well enough you should consult your doctor or pharmacist.

Do not take Migraleve with any other products that contain paracetamol. Many over-the-counter painkillers and cold and flu remedies contain paracetamol. It is important to check the ingredients of any medicines you buy without a prescription before taking them in combination with this medicine. Seek further advice from your pharmacist.

An overdose of paracetamol is dangerous and capable of causing serious damage to the liver and kidneys. You should never exceed the recommended dose of Migraleve. Get immediate medical advice in the event of an overdose with Migraleve, even if you feel well, because of the risk of delayed, serious liver damage.

Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistent heavy drinkers and in people with alcoholic liver disease.

Do not take Migraleve for longer than three days without consulting your doctor. If you take Migraleve regularly for long periods of time, the body can become tolerant to it and it may become less effective at relieving pain. With prolonged use, the body may also become dependent on the codeine. As a result, when you then stop taking the medicine you may get withdrawal symptoms such as restlessness and irritability.

Taking a painkiller for headaches too often or for too long can actually make the headaches worse.

Who should not take Migraleve?

People who are known to have a genetic variation of a liver enzyme called CYP2D6, which metabolises codeine into morphine (CYP2D6 ultra-rapid metabolisers). These people are more likely to experience side effects after taking codeine, because they convert more codeine into morphine than other people. See above.

Migraleve is not recommended for adolescents aged 12 to 18 years whose breathing might be compromised, including those with neuromuscular disorders; severe heart or lung conditions; upper airway or lung infections; multiple trauma; or who have had extensive surgical procedures.

Migraleve should not be used if you are allergic to any of its ingredients. If you feel you have experienced an allergic reaction, stop using Migraleve and inform your doctor or pharmacist immediately.

Who should get medical advice before taking Migraleve?

Elderly people.

People with kidney or liver problems.

People with lung problems such as asthma or a condition called bronchiectasis, in which there is persistent widening of the airways as a result of lung disease, eg infection, inflammation, tumours or cystic fibrosis.

People with biliary tract disorders, eg gallstones or recent surgery on the biliary tract.

Can I take Migraleve while pregnant or breastfeeding?

Get medical advice from your doctor or midwife before using Migraleve if you are pregnant. Migraleve should be avoided during pregnancy and the late stages of labour, unless considered essential by your doctor, and then used only if the expected benefit to the mother outweighs any potential risk to the baby. Paracetamol is not known to be harmful when used during pregnancy. However, the safety of buclizine and codeine during pregnancy has not been established. If codeine is used regularly in the third trimester it may cause withdrawal symptoms in the baby after birth. If used during labour it may cause breathing difficulties in the baby after birth.

If you are breastfeeding you should not take Migraleve. It is not known if buclizine passes into breast milk. Paracetamol and codeine may pass into breast milk in amounts that are probably too small to be harmful in most people. However, because some people metabolise codeine in a slightly different way that can increase the risk of getting side effects from the medicine, it is recommended that women who are breastfeeding do not take codeine. It is impossible to predict which women and babies will metabolise codeine differently. Potential side effects in a nursing baby may include drowsiness or sedation, difficulty breastfeeding, vomiting, breathing difficulties and floppiness.

What are the possible side effects of Migraleve?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with paracetamol, codeine and buclizine. Just because a side effect is stated here does not mean that all people using Migraleve will experience that or any side effect.

Drowsiness. See warnings above.

Dizziness.

Constipation.

Nausea and vomiting.

Dry mouth.

Sweating.

Itching.

Skin rash.

Difficulty passing urine.

Headache.

Confusion.

Blurred vision.

Dependence on the medicine if used regularly or for long periods of time (see above).

Talk to your doctor, nurse or pharmacist if you want any more information about the possible side effects of Migraleve. If you think you have experienced a side effect, did you know you can report this using the yellow card website?

Can I take Migraleve with other medicines?

If you are taking any other medicines, including those bought without a prescription and herbal medicines, it is important to check with your pharmacist or doctor before you take Migraleve as well, to make sure that the combination is safe.

Migraleve should not be taken by people who have taken a monoamine oxidase inhibitor (MAOI) medicine in the last 14 days. MAOIs include the antidepressants phenelzine, tranylcypromine, isocarboxazid and moclobemide and the anti-Parkinson's medicine selegiline.

Don't take other medicines that contain paracetamol in combination with Migraleve, as this can easily result in exceeding the maximum recommended daily dose of paracetamol. Many cold and flu remedies and other painkillers contain paracetamol so be sure to check the ingredients of any other medicines before taking with this one, or ask your pharmacist for advice. (Paracetamol is known as acetaminophen in the USA and some other countries).

It is fine to take Migraleve with ibuprofen.

Migraleve may cause drowsiness. This is more likely if you take it with any of the following, which can also cause drowsiness:

antipsychotics, eg haloperidol, chlorpromazine

benzodiazepines, eg temazepam, diazepam

sleeping tablets, eg zopiclone

other sedating antihistamines, eg chlorphenamine, promethazine, triprolidine, hydroxyzine (some of these may be found in non-prescription cough and cold or hayfever remedies)

Codeine can reduce the muscular activity in the gut and so may oppose the effect of the following medicines on the gut:

domperidone

metoclopramide.

There may be an increased risk of side effects such as constipation, dry mouth and blurred vision if Migraleve is taken with antimuscarinic medicines that can cause these type of side effects, such as the following:

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.